“Patients should be told restorative treatment and material options, risks, benefits, average longevity, etc. (of composite, amalgam, castings, etc.). Then, as a well-respected lecturer sarcastically says, they can ‘pick their poison,'” said a Maryland dentist. “I wonder if, a few decades from now, we will still see the short longevity composites to be as safe as amalgam is and was for 160 years.”

Bisphenol A (also known as BPA), a chemical used in lightweight plastics, dental sealants and dental fillings is back making news headlines once again.

First, the federal government announced this month that baby bottles and sippy cups can no longer contain BPA.

This was followed by reports from a new study stating that children getting dental fillings made with BPA are more likely to have behavior and emotional problems later in life.

The study, as reported in Pediatrics Online, “makes a strong case that in the short-term, use of BPA-containing dental materials should be minimized,” asserts Philip Landrigan, director of the Children’s Environmental Health Center at Mount Sinai School of Medicine in New York City.

The researchers in the study tracked 534 children with cavities from when each child received their first dental fillings. Over the following 5 years, the researchers noted that those children who had cavities filled with a composite material containing traces of BPA consistently scored 2 – 6 points less on 100-point behavior assessments than those who didn’t have fillings.

As reported in Science News, the researchers never administered clinical diagnostic behavioral tests to the children.

Instead, they periodically administered some widely used checklists to the children or their parents, allowing each to self-assess features such as a child’s attitudes toward teachers or others, depression, self-esteem, attention problems, delinquent behaviors, acting-out or problems with attentiveness.

Since the children were 6-12 years old at the time, these type of behaviors are not uncommon for children living with a variety of circumstances like divorce, bullying, and problems at home.

However researchers argue that the behavior problems being reported seemed to happen more with the children who had BPA fillings, causing them to believe that some dental fillings may start to break down over time, thus exposing these children to the chemical.

The U.S. government is currently spending $30 million on its own BPA research to determine the chemical’s health effects on humans.

One of every two dentists is so worried about bisphenol A (BPA) that they think the American Dental Association (ADA) should issue a warning about the chemical’s dangers.

On the other hand, half think we still need more research. “The ADA must respond only to true science,” one dentist declared.

BPA, an ingredient in some dental sealants and dental composites, has been getting a lot of bad press… this could be a serious dental management issue for cosmetic dentistry in the not-too-distant future.

When asked if the ADA should take a stand against dental bisphenol A, here’s what dentists had to say:

“The ADA should conduct a thorough Scientific Study so we do not have another ‘amalgam controversy.'” (Kentucky dentist)

“Whatever the studies show, the ADA needs to get that PR out to the public… If we say nothing, then the only voice the public hears will be other voices.” (General dentist)

“Look into this more fairly before alarming everyone, perhaps unnecessarily.” (New York dentist)

“I think that we need all appropriate in vivo experimental and clinical studies in order for the proper authorities to rule one way or the other.”

“BPA is linked to female issues. We need to be preemptive, even if there is a doubt. What are they waiting for, a return to amalgams?” (Michigan dentist)

“I have a one year old and we make sure never to have him use bottles or other items made of BPA. Most companies that produce products placed in babies mouths are removing BPA from them (bottles, pacifiers, etc). Therefore, why should dentists continue to use dental sealants with BPA? It doesn’t make a whole lot of sense.” (Ohio prosthodontist)

“It is my understanding that BPA itself is not an ingredient in composite materials, but bis-GMA, which is made from BPA. The amount of unconverted BPA in dental materials is almost undetectable and has not been shown to be a health threat. There is also no better alternative material for long-term restoration of the dentition.”

New Health Concerns About Plastic Chemical BPA

Given the recent negative publicity surrounding bisphenol-A (BPA), our survey covered dental sealants and composite. One in four dentists is very worried about the safety of these products.

“It doesn’t matter if composites and sealants are safe,” wrote one respondent. “If public perception is that they are not, it is very harmful to dentistry.”

Here are some additional dentist comments on the subject:

“The enormous and unexplained increase in the incidence of breast cancer corresponds with the advent of the bisphenol-A introduction into dentistry.” (Michigan dentist)

“The cumulative release of BPA from composites appears to be minimal from the available research.” (New Hampshire dentist)

“I had fellow church members ask me if they needed to get all their composites removed.” (New York dentist)

“I am concerned that we are using a material whose biocompatibility is really unknown.” (New York dentist)

“I am particularly concerned about using composites and sealants in children.” (Texas dentist)

“Slow news day?” (Georgia dentist)

“Forget about bisphenol-A. Resins are far more toxic on a cellular level than amalgam. Are you familiar to amalgam studies showing how cells in a petri dish respond to amalgam? They continue to happily divide. When unset resin is placed the cells die!” (General dentist)

“A vegan grilled me the other day. I told him that he was at greater risk from salmonella from not washing his veggies properly!” (Colorado dentist)

“I’m more worried about BPA in soda and water bottles. Patients have never expressed any concern.” (Arizona dentist)

“Most patients assume that if we are doing something it is okay.” (New York dentist)

“It’s the amalgam issue all over again. What are all the ‘Bondadontists’ going to tell their patients now?” (Virginia dentist)

Perhaps you’ve heard the recent news reports of possible health problems with water bottles and other plastic products.

The chemical causing so much concern is bisphenol A, found in some (but not all) plastics. Research suggests that BPA may act like the female hormone estrogen. While hormonal effects have been seen in animal tests, no one has shown the same response in humans.

A Quick Chemistry Lesson

BPA is a monomer used in manufacturing plastics. Monomers are the basic building blocks of plastics; different monomers combined in different ways make different kinds of plastics.

The monomer BPA is also used to make dental sealants and composites, but these products never contain pure BPA. The BPA is chemically bonded to other molecules, making derivatives such as Bis-GMA.

Just because a chemical is a derivative of BPA does not mean that it will have the same estrogen-like effects of BPA or that it will leach BPA.

However, many health experts urge caution, especially with substances that mimic the effect of hormones. Estrogen is a reproductive hormone with feminizing effects, one that has a dramatic impact on sexual development. Some wonder if BPA may be the reason why girls are hitting puberty so early these days. Others fear that a pregnant woman’s exposure to BPA can damage not just the child growing inside her, but that its effect on the fetus’s gonads could harm her grandchildren as well.

BPA exposure is hard to avoid. The chemical may leach into food from plastic containers (especially when heated). In fact, manufacturers of baby bottles now offer BPA-free bottles.

Though plastic bottles have received the most mainstream attention, dentists need to know about another possible avenue for BPA exposure: dental composites and sealants. The dental sealant bisphenol A dimethylacylate is of particular concern.

Dental composites are created from monomers. Composite resin is often based on bisphenol A glycidyl methacrylate (bis-GMA, also known as Bowen’s monomer). Though bis-GMA and some other monomers are chemical derivatives of BPA, BPA itself is not used in dental composites or sealants.

A 1996 study by Nicolas Olea of Spain’s University of Granada was the first to report detectable levels of BPA in the saliva of patients who had just been given dental sealants. The study is still a source of controversy. Further research suggests that some (but not all) dental sealants do raise a patient’s salivary level of BPA. However, blood levels of BPA do not detectably change, and saliva levels quickly return to normal.

This is the dilemma: Yes, there can be detectable levels of BPA. But are they significant?

Some people will tell you that the EPA says it’s okay and the levels of BPA found in humans are far below the levels found to cause problems in animals.

Others will say that the levels of BPA found in humans are well above the levels found to cause detectable hormonal changes in animals.

Some will tell you that dental products cause negligible BPA exposure when compared to food products, water bottles, environmental pollution, and other sources.

Others will say it’s downright irresponsible for dentists to give young children dental sealants that could damage their reproductive development.

I will straightforwardly tell you that I have no idea if any of this is a big deal or not.

I’d like to know what you dentists think! Do you have any concerns about BPA in dental composites and sealants? Have your patients expressed any concerns? (If they haven’t yet, expect them to soon, as the BPA issue gets more press.)

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